MEDICARE: KIMBERLY CHAVEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CMH006289	NM

General Provider Information

NPI Number	:	1235066432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CHAVEZ

Provider Business Mailing Address
First Line	:	3923 RANCHO GUSTO NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 SIERRA NORTE LOOP NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-2520
Country	:	US
Telephone Number	:	505-328-1288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ KIMBERLY CHAVEZ ” Practice Location

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